Transfemoral vs Van Ness Rotation Plasty?

Transfemoral vs Van Ness Rotation Plasty?

Dear Colleagues:
 
I have a young adult who is faced with an amputation, secondary to multiple
trauma and long-standing complications associated with a non-union and
infections, which have resulted in a completely non-functional knee. It is also my
understanding that a total knee is not an option in this case.
 
1. Having said that, has anyone been presented with a similar case, where
the option of having either an above knee transfemoral amputation or a Van Ness
rotation plasty with internal fixation of the proximal femur to the tibia,
via internal fixation, has been proposed?
 
2. If so, would you please share your thoughts and/or opinions, from a
prosthetic point of view, with respect to functional outcome?
 
3. Also, what, if any, psychological issues were encountered or considered
in your patients situation and/or the decision made?
 
I have experience with only one adult who had a Van Ness Rotation Plasty,
secondary to cancer and the option of a hip disarticulation level of
amputation. The outcome in this case has been excellent, given the option of a hip
disarticulation.
 
Aside from the fact weight bearing on the calcaneous, as you cannot bear
weight on the entire plantar surface of the foot, is still better than the
weight bearing options at the transfemoral level and barring no unforeseen
surgical complications with the Van Ness procedure, the question then becomes:
 
4. Given the advancing technology in lower limb transfemoral prosthetics,
the ankle joint be a better knee joint than an advance prosthetic knee joint
system?
 
Thank you in advance for you input and I will post the responses.
 
John N. Billock, CPO/L, FAAOP, Clinical Director
Orthotics & Prosthetics Rehabilitation Engineering Centre
Warren, Ohio 44484 USA